Your care during pregnancy with a serious mental illness

When you are managing a serious mental illness there’s lots of support to help you through pregnancy and beyond. Find out about the people and teams that help you here.

On this page

Your GP's role

Specialist perinatal mental health teams

Community mental health team (CMHT)

Psychological therapy services

Midwifery team and antenatal care

Health visiting team

Mother and baby unit (MBU)

Early help services

Parent-infant relationship teams

Social services


Hormone changes in pregnancy means that your symptoms can come back or get worse even if your illness was very well managed before you became pregnant. That’s why it is important to get help quickly if your mental illness symptoms come back or get worse during this time.

If your symptoms come back or get worse it isn’t your fault and health professionals want to make sure you get the support and treatment you need to help you stay well or get better.

If you’re planning a pregnancy or are already pregnant, don’t stop taking your mental health medication until you have spoken to your doctor.

Your GP's role

You can talk to your GP about your plans for pregnancy and your experience of mental health illness. You could also talk to a doctor in a local family planning clinic.

Your doctor is there to help you, not judge you in any way.

You could try asking the following questions: 

  • How might pregnancy and childbirth affect me?
  • What is the risk of my mental illness coming back or getting worse?
  • What are the risks and benefits of taking my usual mental health medication?
  • How might my mental illness and its treatment affect me during pregnancy and childbirth?
  • How might my mental illness and its treatment affect my ability to care for and enjoy my baby?
  • How could my symptoms be controlled if I stop medication?
  • What mental health services are available for pregnant women in my area?
  • What support is available after my baby is born?

Your GP may refer you to a mental health service if you don’t already see one. They may also arrange for you to have pre-conception counselling , which can help you plan your pregnancy.

Read about the 5 top things to think about before getting pregnant.

Specialist perinatal mental health teams

Specialist perinatal mental health teams are experts in caring for women who have, or had, moderate to severe mental illness before, during and after pregnancy. Perinatal means the time from when you get pregnant to a year after the birth.

The mental health team may include:

  • doctors who diagnose and treat mental illness (perinatal psychiatrists)
  • perinatal mental health nurses
  • health professionals who specialise in talking therapies (perinatal psychologists)
  • other specialist professionals, such as occupational therapists, nursery nurses, social workers and pharmacists.
  • The team works together with the other professionals listed on this page to make sure you and your family have the care you need. They will work with you, and your partner or family if you agree, to put together a plan for your care during and after pregnancy. A member of the team will give you a copy of your care plan and let you know who you can contact if you need support or urgent help.

Where you see your perinatal mental health team will depend on what happens in your area. For example, you may have your appointments at an antenatal clinic, children’s centre or at home.

Your GP or other health professionals can refer you to a perinatal mental health team if you’re planning a pregnancy or if you’re already pregnant. You may see them at a pre-conception counselling appointment if you’re planning a pregnancy. You may also see one or more members of the team if you are referred during pregnancy or after the birth.

The Royal College of Psychiatrists has information on perinatal mental health services.

Find out more here about specific mental illnesses and how they are managed in pregnancy.

Community mental health team (CMHT)

If you’re already under the care of a community mental health team (CMHT), you should tell your care co-ordinator and/or psychiatrist if you’re planning a pregnancy or if you’re pregnant. You can continue to see your usual care co-ordinator and/or consultant.

You can still be referred to the perinatal mental health service if you are under the care of the CMHT. These teams can work together with you and your family.

Psychological therapy services

There are many different types of psychological (talking) therapies. You may be offered individual or group therapy. Mother-infant therapy can help you build a strong relationship with your baby, cognitive behavioural therapy can help anxiety or depressive illnesses and couple therapy can help with any problems in your relationship with your partner.

You can have psychological therapies on their own or together with medicines.

If you think psychological therapies can help you, your GP, midwife or health visitor can refer you to your local psychological therapy service.If you’re in England, you can ask for details of your local Improving Access to Psychological Therapies (IAPT) service, or find these on the NHS website, so you can refer yourself.

IAPT services vary across the country but many offer self-help and cognitive behavioural therapy for individuals, groups and couples. In some areas there are groups for pregnant women or new mums. 

If you are under the care of a perinatal mental health service, you can have psychological therapy with the perinatal community mental health team. There are also other psychological therapies services which your GP or the perinatal mental health team can refer you to, depending on the type of therapy you need.

Midwifery team and antenatal care

Midwives ask all women at their first appointment about any physical and mental health problems. Telling your midwife about any past or current mental illness means they can recommend sources of help and support in your area. They can refer you to your local psychological therapy service or to the perinatal mental health service if needed.

Your mental illness means that you can sometimes have extra care in pregnancy. Ask at your booking appointment if they can offer ‘continuity of care’. This means you can see the same named midwife or small group of midwives through your whole pregnancy. This builds trust and has been shown to benefit mothers and babies.

Health professionals should ask you about your mental health and any symptoms at each of your antenatal (during pregnancy) appointments. Being honest about your symptoms will allow them to give you any support you may need.

Some hospitals have a specialist mental health midwife, who you may see during your pregnancy. All hospitals have a doctor who specialises in pregnancy and childbirth (obstetrician). You may see an obstetrician during pregnancy and in the days after you give birth. Midwives and obstetricians work closely with perinatal mental health teams.

All women remain under the care of a midwife until 10 days after the birth.  If you have a serious mental illness or a risk of severe mental illness after birth, the midwives may continue to see you for up to 28 days after your baby is born.

Health visiting team

Your health visitor will give you advice on caring for your baby and may offer listening or counselling services, where you can talk about any worries you may have. They will work closely with your GP and any mental health professionals you are seeing to make sure you have the care and support you need.

Some women will meet their health visitor before birth towards the end of pregnancy. This is more likely if you have a severe mental health problem. All women will see their health visitor at home 10 to 14 days after the birth. You will then continue to see them either at home or in a clinic.

If you are a young parent you may also have support from a family nurse.

Mother and baby unit (MBU)

Mother and Baby Units are specialist inpatient psychiatric units. They are a safe place for you to stay with your baby if you need inpatient treatment for severe mental illness. They look after women who are in the late stages of pregnancy or in the first year after birth.

Sometimes, women may stay in the MBU for a few weeks to prevent their mental illness getting worse, if they and their doctor decide this is needed.

If you’re not sure if you want to stay in the MBU, you can usually visit the unit first to find out what it’s like to stay there and to ask any questions you may have. Some NHS Trust mother and baby units have made video tours for the trust website that may be helpful.

This is an example from Yorkshire and Humber Mother and Baby Unit:

Staff at Mother and Baby Units are experts in treating mental health problems in pregnancy and after birth. They will also support your developing relationship with your baby. These professionals include psychiatrists, mental health nurses, psychologists, occupational therapists, social workers and nursery nurses.

When you’re ready to leave the Mother and Baby Unit, a plan will be made with you (and your partner or other carer if you have one) to make sure you continue to get treatment and support at home. You and your family will be able to get 24-hour telephone advice from the unit for at least 4 weeks after you go home.

Some parts of the country don’t have a close Mother and Baby Unit or, if they do, they may be full. If there isn’t a space available near your home, speak to your perinatal mental health team about your options.

You may be able to travel to a unit in another area, but this may be a long way from your home. Or you may stay for a short time in an adult psychiatric hospital until a space becomes available in an MBU. In this case, your baby would have to stay with someone else while you’re in hospital.

Some women may be able to have treatment at home until an MBU bed is available. In this case you may have support from the psychiatric home treatment team and the community perinatal mental health team (CMHT).

Early help services

If you and your family need extra support on practical matters, you may be offered a referral to your local early help service.

Early help services bring together support from several organisations, such as healthcare, housing and education. They aim to find out, at an early stage, what support you need to look after your baby and any other children. This can help stop any problems getting worse.

Support may include parenting classes, having a support worker or help with getting a nursery place for older children.

Any professional who helps care for you or your child can refer you to early help services with your agreement.

Parent-infant relationship teams

These teams are made up of professionals who will help you with your mental health and support you in building a strong relationship with your baby. They are sometimes called parent-infant mental health services, early child and adolescent mental health services (early CAMHS) or early attachment services.

There are only a few of these teams in the UK. If you don’t have one in your area, speak to your GP or perinatal mental health team to find out what support is available to you.

Family and friends

Your partner, if you have one, or family and friends are a very important source of support. They can help you after the birth by:

  • cooking healthy meals for you
  • looking after other children so you can get some rest
  • taking the baby for a walk so you can get some sleep
  • doing any household chores for you, such as cleaning or laundry
  • spending time entertaining the baby while you take a break – even if it’s just to have a bath or shower.

Make sure your close family and friends understand your condition and how it affects you. For example, you could talk to them about:

  • your main symptoms
  • what medication you take
  • how to recognise the triggers and signs of an episode of depression or mania
  • who they need to contact in case you become unwell.

Having a newborn is tiring and causes lack of sleep, which may trigger mental illness. Family and friends can help you spot the early signs of a relapse so you can get help as soon as possible.

If you’re having symptoms of a mental illness, you may need help to look after your baby. This isn’t your fault and there is support available to help you.

Read more about relationships and support networks when pregnant with a severe mental illness

Organisations such as Family Lives and Family Action have information about getting support after your baby is born.

Social services

In most cases, women with mental illness are able to care for their babies at home with support from family, friends and health professionals. But some women will need further help from children’s social care, which is also known as social services.

Sometimes women worry that if social services need to be involved, it means that professionals think they can’t look after their baby. This isn’t usually the case. Social services want to get you the support you need to care for your baby at home.

A professional would usually ask for your agreement before referring you to social services, unless they think your baby is at risk of harm.

You or a family member can ask for help from social services by contacting your local authority.

If you are referred to social services, a social worker may arrange to visit you at home. This is a chance to talk about how you are coping and how your baby’s needs are being met.

Your social worker will assess your and your baby’s needs and will want to work with you to organise the right support.    

A social services assessment will:

  • check what support you have from family, friends and professionals
  • make sure there is a plan for your baby if you are too unwell to care for him or her.

If you don't have any extra help from family members while you are unwell and during recovery, social services may be able to help. They can also find a temporary carer for your baby if you need to go into hospital and you don’t have any family or friends who can look after your baby or there’s no place available in a Mother and Baby Unit.

You can find out more about what to expect from social services from Family Lives and the Royal College of Psychiatrists.

Worries about having your child removed

Many women worry that if they have, or have had, a mental illness, health professionals will want to remove their baby.

This is not the case. Removing a baby is rare and always a last resort and only a court can decide whether or not to remove a baby from their parents, unless a baby is in immediate danger.

Health professionals are there to help you stay well during pregnancy and afterwards and to ensure you have the right help and support so you can care for your baby.

Sometimes women report having had negative comments from, or feeling judged by, a health professional because of their mental illness and plans to have a baby. If this is the case, it should not have happened.

It is your right to have a child when you choose and health professionals usually respect this. If you have been in hospital recently to treat a mental illness, your doctor, or another professional, may recommend that you take time to recover so that you are well before trying to have a baby, but this is your decision.

Most women who have a current or previous mental illness will not be referred to children’s social services. If any professional thinks that a referral to social services is needed, they will talk to you about the reasons for this.

If a referral is made, an assessment by a social worker may or may not be needed. The social worker will talk to you about any concerns they have. They will discuss with you what extra help and support is available so that you can care for your baby, and any other children you have, safely.

More information and support

Action on Postpartum Psychosis (APP)

Information and support on postpartum psychosis, online chatroom, peer support network.

Bipolar UK
Information and support, local groups and an online chatroom for people with bipolar disorder.

Bipolar Fellowship Scotland
Information, support and advice for people with bipolar disorder.

MIND
Mental health charity providing information, support, local groups and an online chatroom

Mumsnet
Although they do not provide advice Mumsnet has a very supportive mental health forum.

PANDAS (Pre and Postnatal Depression Advice and Support)
Provides telephone support, online information and local support groups for pregnancy depression and postnatal depression.

Rethink
Supports people across England to get through mental health crises, to live independently and to realise they are not alone. Find a support group in your area.

Royal College of Psychiatrists
Includes information on pregnancy and mental health.

Samaritans
Confidential service offering emotional support to those in need.
Call them on 08457 90 90 90.

Sources

[1] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[2] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[3] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[4] Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf

[5] NHS England, NHS Improvement, National Collaborating Centre for Mental Health (2018) The Perinatal Mental Health Care Pathways. London: NHSE

[6] NHS England, NHS Improvement, National Collaborating Centre for Mental Health (2018) The Perinatal Mental Health Care Pathways. London: NHSE

[7] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[8] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[9] NHS (2017) Implementing Better Births: Continuity of Carer. https://www.england.nhs.uk/publication/implementing-better-births-continuity-of-carer/

[10] NHS England, NHS Improvement, National Collaborating Centre for Mental Health (2018) The Perinatal Mental Health Care Pathways. London: NHSE

[11] Royal College of Obstetricians and Gynaecologists (2011) Management of Women with Mental Health Issues during Pregnancy and the Postnatal Period: Good Practice No.14. https://www.rcog.org.uk/globalassets/documents/guidelines/managementwomenmentalhealthgoodpractice14.pdf

[12] Pan-London Perinatal Mental Health Networks (2019) Pre-birth planning: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/01/Pre-birth-planning-guidance-for-Perinatal-Mental-Health-Networks.pdf

[13] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[14] Pan-London Perinatal Mental Health Networks (2019) Pre-birth planning: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/01/Pre-birth-planning-guidance-for-Perinatal-Mental-Health-Networks.pdf

[15] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[17] Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf

[19] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[21] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[22] Department for Education (2018) Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children London: HM Government https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard-Children.pdf

[23] Royal College of Psychiatrists (2018) Children's Social Services and Safeguarding https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/children's-social-services-and-safeguarding

[24] Department for Education (2018) Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children London: HM Government https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard-Children.pdf

[25] Hogg S. (2019) Rare Jewels. Specialised parent-infant relationships teams in the UK. https://parentinfantfoundation.org.uk/our-work/campaigning/rare-jewels/#fullreport

[26] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[27] Darwin Z et al. (2020) Involving and supporting partners and other family members in specialist perinatal mental health services: Good practice guide. Unpublished.

[28] Royal College of Psychiatrists (2018) Children's Social Services and Safeguarding https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/children's-social-services-and-safeguarding

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    Last reviewed on July 24th, 2020. Next review date July 24th, 2023.

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